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Latest Posts

Is The Prescription Of Real Exercise Underused?

I recently wrote about the incredible sensations that come with vigorous exercise. Perhaps it was the post ride cannabinoid flurry, but it’s possible that I went too far in suggesting that ‘we’ (doctors, patients, the whole of Western Society) default first to pills before healthy living.

Two commentors called me out on this snark. They wrote about valid points.

One comment focused on the fact that her AF medicines were causing side effects that made vigorous exercise difficult. The second objected to my inference that exercise alone could substitute for the many benefits of modern medicine.

To the idea that medicine Read more »

*This blog post was originally published at Dr John M*

Experience In Medicine Has Its Downsides

You have probably read that experience makes for better doctors.

And of course this would be true–in the obvious ways, like with the hand-eye coordination required to do complex procedures, or more importantly, with the judgment of when to do them.

There’s no news here: everyone knows you want a doctor that’s been out of training awhile, but not so long that they have become weary, close-minded or physically diminished. Just the right amount of experience please.

But there’s also potential downsides and struggles that come with experience. Tonight I would like to dwell on three ways in which experience is causing me angst.

But first, as background…

It was the very esteemed physician-turned-authors, Dr. Groopman and his wife, Dr. Hartzland, who wrote this thought-provoking WSJ essay–on how hidden influences may sway our medical decisions–that got me thinking about how I have evolved as a doctor. They were writing from the perspective of the patient. But in the exam room, there are two parties: patient and doctor.

# 1) The sobering view that experience brings: Read more »

*This blog post was originally published at Dr John M*

Would You Be Able To Recognize Chest Pain As Heart Disease?

Most people are pretty good judges of what’s going on with their own bodies. But telling a heart attack from other causes of chest pain is tough stuff—even, it turns out, for highly trained doctors. That’s why I thought this personal story, written by a Harvard doctor who has heart disease, would make an interesting read. It’s an excerpt—the full version can be found in Heart Disease: A guide to preventing and treating coronary artery disease, an updated Special Health Report from Harvard Medical School.

Early one spring, I noticed a burning sensation high in my abdomen whenever I walked up a hill or worked out on the treadmill. I felt perfectly healthy otherwise. I had lots of energy and could do high-level exercise on the treadmill—once the burning sensation went away—without becoming short of breath. I thought it was just heartburn, so I started taking powerful acid-suppressing pills. They didn’t help.

Sometimes when I would feel the burning in my chest, I would remember an old saying to the effect that “A doctor who takes care of himself has a fool for a patient.” Still, I hesitated; I didn’t want to waste the time of a cardiologist if all I had was heartburn.

But one morning as I walked across the street from the garage to my office in the hospital, Read more »

*This blog post was originally published at Harvard Health Blog*

Is The Ironman Triathlon Safe For The Middle-Aged Heart?

Before I even start, let me say this to my triathlete friends…

I really like you all. And…I am sorry for how I feel about your sport’s pinnacle, the Ironman triathlon. But I was poked into writing this post. When asked the question of whether the Ironman is safe for the middle-aged heart, what was I to do? Lie?

Each August, my hometown, Louisville, KY, gets overrun, over-swum and over-ridden with “Iron people.” No, these humans aren’t rust colored, or all that hardened, but they are indeed a determined lot. Triathletes, or iron people if you will, wake up before sunrise to swim, bike or run. Then they eat; some go to work (barely), and then they do the training thing again in the evening. Calling these athletes focused would surely be an understatement.

So it is each summer that I endure the same question: “Dr. Mandrola, did you do the Ironman?”

“No…I just ride bikes.”

But this year was different. Before I could launch into my usual dissertation on how training for Ironman-length triathlons causes excess inflammation, coronary calcium, atrial fibrillation, divorce, etc., etc., another question quickly popped up.

“What did you think of that guy who died during this year’s race?” Read more »

*This blog post was originally published at Dr John M*

Medical News Stories: Beware Of Insufficient Evidence

After seeing the NBC Nightly News last night, a physician urged me to write about what he saw: a story about a “simple blood test that could save women’s lives.”

Readers – and maybe especially TV viewers – beware whenever you hear a story about “a simple blood test.”

And this is a good case in point.

Brian Williams led into the story stating:

“Two of three women who die suddenly of cardiac heart disease have no previous symptoms which is all the more reason women may want to ask their doctors about a blood test that can be a lifesaver.”

Then NBC News chief medical editor Dr. Nancy Snyderman said:

“It’s not a new test, it’s not an experimental test but nonetheless it’s a test not a lot of people know about and that’s a problem because this simple blood test could save your life.”

The test in question is Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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